Ethical and Legal Implications of Prescribing Drugs

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Scenario: “As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.”

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Solution

Ethical and Legal Implications of Prescribing Drugs

Introduction

According to John Hopkins patient safety experts, medical errors in the United States of America contribute to more than 250,000 deaths annually (McMains, 2016). The top three diseases causing death in the US, defined by the Centre for Disease Control and Prevention (CDC) in 2013, are heart disease, cancer, and respiratory diseases. McMains (2016) stated that medical errors replaced respiratory disease and became the third leading cause of total deaths in the US. Regardless of the medical errors becoming the third cause of deaths and the implementation of rules to control these medical errors, there remains a gap because some physicians are still at a point of medicating drugs wrongly. Consequently, the purpose of this essay is to identify the ethical and legal implications of medical errors to various stakeholders led by patients. As such, the essay explores a scenario where a nurse wrongly prescribed an overdose to a child by having the child take adult dosage. Concerning the medical error, the paper sets to discuss the strategies that address disclosure and nondisclosures with specific reference to Texas state laws and strategies that an advanced practice nurse should use to guide their decision-making. Additionally, the essay delves into measures that would help clinicians understand the process of prescribing strategies, which may help minimize medical errors.

Ethical and Legal Implications to Various Stakeholders

Just because the medical profession helps to preserve life, healthcare is a noble profession. When a patient approaches a doctor, the doctor owes some duties to his patients. Among the duties is the role of care in deciding whether to deal with the matter, what treatment the patient should take, and prescribing the appropriate treatment. A breach of one of these roles may lead to the cause of action for negligence, and the patient may recover damages from his doctor (Sorrel, 2017). The healthcare provider should inform the incidence and provide supporting information concerning the error. To the patient, a medical error causes harm and injuries and, to some extent, even leads to death. Ethically, all patients should be treated with dignity and require protection from any harm. Additionally, doctors should also possess the knowledge of potential failures of the patient’s safety. Patients and family members have the right to know the truth if any medical errors occur. In the current situation, the healthcare providers need to inform the child’s parents about the incidence and get an assurance that all the costs will be paid for, which would be better if the Chief Physician or the Head Nurse informed the parents.

Addressing the Disclosure and Non- Disclosure in Texas State

Mastroianni et al. (2010) aver that as stipulated in Texas State statutes, patients expect to be told about medical mistakes or errors at times, also referred to as unexpected outcomes during the care process. Disclosure and apology concepts are outlined within Texas laws. Within the current context, the nurse should disclose what happened, how it happened and plans to prevent such occurrences in the future. While the disclosure requirement is codified into various state legislations, significant gaps still abound between existing practice and the expected that the affected patient would be notified of the medication error. The resulting communication breakdown increases the patient’s distress and the urge to seek legal redress (Phillips-Bute, 2012). In Texas, agencies must remove one’s criminal record if one secures an expunction order. For these to happen first, one needs to qualify. People can clear their criminal records, which did not lead to convictions. Checking one’s eligibility is the second where the victim needs first to check the offense’s eligibility for a nondisclosure order or expunction. On the crime, it is best to consult a lawyer before starting the expungement process (Love et al., 2018). By filling one’s petition with the court that handled one case earlier, it makes it easier to initiate the process of expunction of one’s record. If the expunction is not eligible in Texas, nondisclosure of one’s criminal record is possible, where the agencies holding one’s records are commanded to restrict access of one’s records.

Strategies to Guide the APRN Decision Making

One of the strategies to use based on decision making is considering the harm the error can cause to the patient, which needs high decision-making capacities. About healthcare, legal capabilities to process information, make decisions and be aware of the same consequences. To have the patient or guardian’s capacity to understand the meaning of the information from the physician (Vaismoradi, 2020). The child’s parent needs to have the ability to determine the relevance of the facts to their situation. The patients also need to use reasoning on the information provided by the nurse to make a decision concerning their care. Another strategy is by using shared decision making a model where patients and physicians came to a joint conclusion on the best treatment. This empowers the child and the mother and leads to better healthcare results and increases patients’ satisfaction. As the physician who wrongly prescribes the drug, considering the harm it can cause to the child and the family, I would feel no harm when I disclose this to the management for further actions regardless of the outcomes I may come across. However, as an advanced nurse, it is always best to disclose these errors.

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Ethical and Legal Implications of Prescribing Drugs
Ethical and Legal Implications of Prescribing Drugs

Process of Writing Prescriptions

Kumar et al. (2018) note that significant steps are followed with the first step being able to evaluate and understand the patient’s problem in prescribing drugs. The second step is when the therapeutic objective is specified. The third step needed when prescribing the drugs to patients is the selection of the appropriate drug therapy. On the fourth step of prescribing drugs, relevant details are initiated with therapy, and No pharmacologic therapies are considered, and the end step is providing information, instructions, and warnings. The ten strategies for preventing medications errors are ensuring the medication administration rights, properly follow the procedure in medication reconciliation, reread or even triple check the procedure, have the nurse reread it, use of name alert should be considered in front of the decimal point place a zero, and finally, everything should be documented.

Conclusion

In the conclusion of the essay, has established that medical errors are preventable. Through discussing the ethical and legal implications of medical errors, medical professions need to understand that they have a role in protecting the patient’s life. Also, medical professions need to understand medical error cause significant harm, injuries, and death at the healthcare provider’s cost. Ethically, all patients should be treated with dignity and should be protected from any harm. In prescribing drugs, healthcare professions need to be careful, and these deaths caused by medical errors in the US can decrease.

References

Kumar, A., Jain, S., Dangi, I., Chowdary, S., Choubitker, O., Pandey, K. K., & Pawar, R. S. (2018). Ideal drug prescription writing. World journal of pharmacy and pharmaceutical sciences8(3), 634-654.

Love, M., Gaines, J., & Osborne, J. (2018). Forgiving & Forgetting in American Justice: A 50-State Guide to Expungement and Restoration of Rights. Federal Sentencing Reporter30(4-5), 348-360.

Mastroianni, A. C., Mello, M. M., Sommer, S., Hardy, M., & Gallagher, T. H. (2010). The flaws in state ‘apology’and ‘disclosure’laws dilute their intended impact on malpractice suits. Health Affairs29(9), 1611-1619.

Phillips-Bute, B. (2012). Transparency and disclosure of medical errors: It’s the right thing to do, so why the reluctance. Campbell L. Rev.35, 333.

Sorrell, J. M. (2017). Ethics: ethical issues with medical errors: shaping a culture of safety in healthcare. OJIN: The Online Journal of Issues in Nursing22(2).

Question

Scenario: “As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.”

Write a 2- to 3-page paper that addresses the following:

  • Explain the ethical and legal implications of the scenario on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
  • Describe strategies to address disclosure and nondisclosure as identified in the scenario. Be sure to reference laws specific to the state of Texas.
  • Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
  • Explain the process of writing prescriptions, including strategies to minimize medication errors.

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